Best Practice

RELEVANCE

The programme’s main objective is to make zidovudine accessible for HIV-infected Thai women with help from the community. The spread of HIV/AIDS in Thailand is mostly by heterosexual transmission. The increasing number of HIV-infected women has led to a large number of children born with this disease. Without interventions, the country will have to face with a significant number of paediatric HIV cases. The medical care for these children will be very costly and may well be a burden for the country. Therefore, every effort must be made to reduce the number of those affected children. This programme concentrates on providing free zidovudine to prevent transmission of HIV from pregnant women to infants and it should be considered as one of the options for these women. This initiative should be viewed as a pilot project. With respect to convincing the society that intervention strategies can be implemented even in the resource-poor setting, it has been successful.

EFFECTIVENESS AND EFFICIENCY

The programme is administered by the Thai Red Cross AIDS Research Centre headed by the Thai Red Cross Society. Since this is not a research project, the administration structure is organised to be efficient while maintaining flexibility in operations. The programme has set certain criteria in an attempt to ensure that zidovudine will be offered to those who are truly unable to afford the medication. This has met the donors’ expectation that the funds or the medication they donate should go to those who really need it. It also ensures that the programme will not be abused.

The programme, with the help from the public relation and fundraising committees of the Thai Red Cross, has invited participation from the public and private sectors in both publicizing this programme and providing financial support. This kind of cooperation has continued to grow.

As was previously mentioned, the effectiveness of this programme has been reflected by the low transmission rate of 5.9 per cent. The programme and its results were recently presented at the Second Conference on Global Strategies for the Prevention of HIV Transmission from Mothers to Infants in Canada.

ETHICAL SOUNDNESS

This programme is operated by the driving force of charity and humanity from the community. The medication that the Thai Red Cross purchases is used exclusively for the programme. Moreover, no request has ever been rejected and we believe that the medication is equally allocated to all. The existence of this programme has stimulated health care providers in Thailand to include the discussion of HIV as a relevant health concern for every pregnant woman and to offer the voluntary counselling and testing services. The programme has also set the standard of care for HIV-infected pregnant women and has helped shape the direction and the ethics of the clinical research on mother-to-child transmission in this country and in the developing world.

SUSTAINABILITY

This programme has been operating for almost 4 years. Judging by the number of request, the level of donations, and the amount of the medication allocated each year, it is evident that there is a continuing need for this programme. However, it needs to be kept up-to-date with the new medical and social information. We believe that as long as HIV/AIDS remains a public health problem for Thailand, the ‘community-to-community’ programme of this kind must exist. It could be one of a few weapons that the society has to combat and control this deadly disease.